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Asian Nursing Research 9 (2015) 336e341

Contents lists available at ScienceDirect

Asian Nursing Research


journal homepage: www.asian-nursingresearch.com

Research Article

Cardiovascular Surgery Patients: Intensive Care Experiences and


Associated Factors

Ozlem Aslan, RN, PhD, * Betül Tosun, RN, PhD
Department of Fundamentals of Nursing, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey

a r t i c l e i n f o s u m m a r y

Article history: Purpose: The purpose of this study was to determine the intensive care unit (ICU) experiences of car-
Received 26 March 2014 diovascular surgery (CS) patients and to define the associations between their ICU experiences and
Received in revised form related factors.
19 November 2014
Methods: The study used a descriptive design. In total, 106 CS patients were interviewed at least 24 hours
Accepted 2 October 2015
after discharge from an ICU in an educational research hospital in Ankara, Turkey between January and
July 2012. Data were collected using the Intensive Care Experience Scale (ICES), a sociodemographic and
Keywords:
clinical characteristics data form and two open-ended questions inquiring about smells and light. Sta-
cardiac surgical procedures
inpatients
tistical analyses were conducted using SPSS 15.0.
intensive care Results: The patients were moderately aware of their ICU environments, partly recalled their ICU ex-
periences, highly recollected frightening experiences, and expressed good satisfaction with care. Age,
education, marital status, and pain were associated with ICU experiences. Patients who sensed smell had
higher scores of frightening experiences than those who did not. Patients who were annoyed with
excessive light reported less satisfaction with care than those who were not.
Conclusions: The results suggest that measuring the patients' characteristics and environmental factors
may be beneficial for healthcare teams to improve the recovery of CS patients in the ICU.
Copyright © 2015, Korean Society of Nursing Science. Published by Elsevier. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction experiences [17], sudden illness, unusual intensive care environ-


ments, and feelings of uncertainty made it difficult to interpret
Intensive care patients are faced with unusual and unfriendly patient experiences [12]. Some patients had bright and strong
environments [1]. Longer recovery times from any critical illness memories [5], whereas longer durations of mechanical ventilation
and long-term and short-term patient outcomes may be related to were associated with a significant decrease in environmental
the patients' perceptions of their intensive care unit (ICU) experi- awareness [18]. Additionally, older patients were more aware of the
ences [2]. Traumatic cardiovascular surgery experiences cause ICU [19]. In total, 44% of patients remembered their dreams during
disturbing recollections and post-traumatic stress disorder [3]. their stay in the ICU; there was a significant association between
Research on intensive care experiences of cardiovascular surgery the length of stay in the ICU and patients' dream experiences [11]. A
(CS) patients is very limited [4e7]. The ICU experiences of patients total of 15.0% of patients did not recall events in the ICU, and some
other than cardiovascular surgery have been primarily reported in of them remembered real memories, such as visits from family
the scientific literature [8e13]. Additionally, standardized measure- members [10].
ment tools were not used in the majority of these studies, and there Patients generally had negative experiences in the ICUs. CS pa-
were many differences concerning the ICU characteristics and the tients reported apprehension, fear, anxiety, confusion and halluci-
time interval between the ICU experiences and interview [14e16]. nations related to their stay in the ICU [20]. Postoperative coronary
CS patients insufficiently recalled or did not recall at all their artery bypass graft patients expressed themes including a lack of
stay in the ICU. While all the ICU patients recollected some of their comfort, damaged communication, loss of control, loneliness, being
transitory and human interaction [21]. Mechanically ventilated

* Correspondence to: Ozlem Aslan, RN, PhD, Department of Fundamentals of patients expressed themes such as being in an unusual environ-
Nursing, School of Nursing, Gulhane Military Medical Academy, GATA Hemsirelik
Yüksekokulu, 06010, Etlik/Ankara, Turkiye.
ment, physically and psychologically suffering [9], feeling helpless,
E-mail address: oozlem.aslan@gmail.com and feeling abandoned and powerless [8]. There was a significant

http://dx.doi.org/10.1016/j.anr.2015.10.003
p1976-1317 e2093-7482/Copyright © 2015, Korean Society of Nursing Science. Published by Elsevier. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
€ Aslan, B. Tosun / Asian Nursing Research 9 (2015) 336e341
O. 337

relationship between the patients' perceptions of their ICU expe- the patients' ICU experiences and their sociodemographic and
riences and their scores for depression, anxiety, avoidance and clinical characteristics, as well as the smell and light factors in the
intrusion [2]. ICU environment.
There are limited studies reporting that patients had positive
experiences when staying in the ICU [13,22,23] such as emotional, Methods
perceptual and environmental comfort [13]. Cardiovascular surgery
patients in the ICU expressed positive themes in addition to nega- Study design
tive ones. Some of the positive themes were comfort, getting better
and hope [5]. Another study determined that ICU patients remem- Descriptive design was used in the study.
bered pleasant memories in addition to unpleasant ones [13].
ICU patients mostly recollected frightening experiences [22]. CS Setting and sample
patients defined several painful experiences in the ICU, including
chest tubes, endotracheal suctioning, being on a bed with an air This study included 106 adult CS patients who had been dis-
pattern, and wound dressing changes [4]. Other studies revealed charged at least 24 hours or more (24e48 hours) from a CS ICU in
that CS patients felt restless and painful during their ICU stay [24]. an education and research hospital in Ankara, Turkey between
Patients indicated that they emotionally drove similarity between January and July 2012. The patients were conscious, orally
staying in the ICU and being dead [25], and a lack of social support communicable and volunteered to participate in the study. The
was comparable to death [12]. sample size was determined with regard to the number of items in
Patients' satisfaction with care was related to various factors. the Intensive Care Experiences Scale (ICES). The scale is composed
The quality and presence of the nursing personnel was important of 19 items, with 5-point Likert scales for each item. In accordance
for patients in the ICU following cardiovascular surgery [15]. Sup- with Gorsuch, the subject-to-item ratio of 5:1 was adopted as
ported by this result, CS patients receiving vigilant and individu- acceptable [31]. The sample size was determined to be 95 patients.
alized care felt secure in the ICU [20]. The nurses supported their
patients by performing preoperative visits, providing continuous Ethical consideration
and repeated explanations to patients, encouraging family visits,
and providing sufficient sleep and pain control. Across these situ- Written permission was obtained from the authors, who adapted
ations, patients remembered that they had felt safe in the ICU [17]. the Turkish Version of the ICES. Ethical approval, which agreed with
Positive ICU environments positively affected patient recovery [26]. the principles in the Declaration of Helsinki [32], was obtained from
However, increased periods of mechanical ventilation were asso- the local university ethical council prior to the study. The patients
ciated with reduced satisfaction with care [18]. Care in the ICU was gave their written informed consent to participate in this study.
perceived as a stressor by the patients [13].
The following items are four essential factors on ICU environ- Measurements/instruments
ment, which frequently affect patients' experience of stay. The
factors are (a) the smell factor, which includes eliminating smells Sociodemographic and clinical characteristics form
and regulating fragrances; (b) the voice factor, which includes This form included 11 variables (sociodemographic and clinical
pleasant sounds and removing excessive noise; (c) the light factor, characteristics of patients, pain levels of patients). Additionally, two
which concerns natural lighting; and (d) natural environments and open-ended questions on smell and light were prepared. Items
recovery space, where the individuals can feel comfortable [27]. regarding smell and light were not available in the ICES.
Removing barriers to healing and increasing a patient's feeling of
safety are necessary to support patient recovery [1]. Cardiac Visual Analog Scale
transplant patients did not recognize their ICU environment [7]. The Visual Analog Scale (VAS), first developed in 1921 by Hayes
Patients stated that they felt environmental distress while in the and Patterson [33], is commonly used to measure clinical phe-
ICU [13]. Some ICUs do not have natural light [28]. Additionally, the nomena, including pain and comfort. The VAS is a method for
use of aromatherapy results in improvements in the mood and converting certain qualitative measures to quantitative measures. It
anxiety levels of ICU patients [29]. is easy to use and requires very little written language [34]. On the
Some sociodemographic factors can have an impact on the ex- two ends of a 10 cm (100 mm) line, extreme definitions of a
periences of patients. It was reported that age and marital status parameter are written, and the patient is asked to indicate his or her
affected patient's ICU experiences positively or negatively [10,19]. current status. For instance, in dealing with pain, one end of the line
Some researchers did not find any associations among these factors is “no pain”, and the other end is “severe pain” and the patient
[19,22,30]. indicates his or her current level of pain on the scale. The distance
The ICU contains various biotechnological devices. In this from “no pain” to the patient's mark quantitatively represents the
physically complicated setting, the nurses have a key responsibility patient's pain level [35].
in the decision-making process with other healthcare team mem-
bers. The scarcity of research on the ICU experiences of CS patients, ICES
not using any standardized tool to measure the ICU experiences of The ICES was developed by Rattray, Johnson, and Wildsmith [36]
CS patients, unavailability of studies aiming at determining asso- and adapted to Turkish by Demir, Korhan, Eşer, and Khorshid [37].
ciations between related factors and ICU experiences of CS patients The ICES consists of 19 questions using a 5-point Likert scale for the
due to different study designs implied a need on further research. responses; patients were required to select only one response per
Determining patient experiences will provide specific data to item. The Cronbach a coefficient was .79 in Turkish ICU patients
healthcare teams to make appropriate arrangements in the CS ICU demonstrating the established internal consistency of the instru-
environment and make successful decisions to support the pa- ment [37]. The Cronbach a was found as .73 in our study. Four
tients' recovery process. subscales of the ICES are Awareness of Surroundings, Recalling of
The aims of this research were (a) to determine the ICU expe- Experiences, Frightening Experiences and Satisfaction with Care.
riences of cardiovascular surgery patients at least 24 hours after The Awareness of Surroundings subscale scores ranged from 5
discharge from the ICU, and (b) to define the associations between to 25; high scores indicate a high environmental awareness. The
338 € Aslan, B. Tosun / Asian Nursing Research 9 (2015) 336e341
O.

Recalling of Experiences subscale scores ranged from 4 to 20, where Table 1 Sociodemographic and Clinical Characteristics of Study Participants (N ¼ 106).
high scores indicate a good recall of experiences. The Frightening
Characteristics n (%) M ± SD
Experiences subscale scores ranged from 6 to 30; high scores
indicate many frightening experiences in the ICU. The Satisfaction Age (yr) 59.73 ± 13.20
< 65 67 (63.2)
With Care subscale scores ranged from 4 to 20; high scores indicate
 65 39 (36.8)
a high level of satisfaction with care [38]. Duration of stay in ICU (days) 2.23 ± 2.89
Duration of mechanical ventilation (hours) 7.86 ± 4.16
Data collection/procedure Gender
Female 30 (28.3)
Male 76 (71.7)
The ICES, a data form requesting information about the patients' Marital status
sociodemographic (age, gender, education, marital status) and Married 89 (84.0)
clinical characteristics, and two open-ended questions were used to Single 17 (16.0)
collect the data. Having any visitors, witnessing of death of another Education
Primary school 58 (54.7)
patient during their ICU stay were also inquired. The researcher
High school and higher 48 (45.3)
conducted 22-minute face-to-face patient interviews. Clinical Another chronic disease
characteristics were taken from the patient's records. Patient pain Yes 72 (67.9)
levels were measured using the VAS during their stay in the ICU, No 34 (32.1)
and mean pain scores were calculated. Pain scores between 1 and 5 Any experience before this admission
Yes 61 (57.5)
points were defined as “mildemoderate pain”. Pain scores more
No 45 (42.5)
than 5 points were defined as “severe pain”. The level of con- Mechanical ventilation in ICU
sciousness (by Glasgow Coma Scale) was obtained from patient Yes 104 (98.1)
records before data collection. The following open-ended questions No 2 (1.9)
Feel bad smell
were used: (a) Did you sense any smell in the ICU? If yes, was it a
Yes 29 (27.3)
bad or nice smell? (b) Were you annoyed with the lighting in the No 77 (72.6)
ICU? If yes, was it excessive or mild? Excessive light
Yes 21 (19.8)
Data analysis No 85 (80.2)
Comorbidities
Yes 72 (67.9)
Data were analyzed using Statistical Package for the Social Sci- No 34 (32.1)
ences (SPSS) for Windows 15.0 software (SPSS Inc., Chicago, IL, Any visitors
USA). Descriptive statistics (frequencies, percentages, mean and Yes 41(38.7)
No 65 (61.3)
standard deviations), student's t tests and Mann-Whitney U tests
Being witness to any death in ICU
were used for the two independent groups. Yes 13 (12.3)
Answers to the open-ended questions regarding smell and light No 93 (87.7)
were shown by frequencies and percentages. These answers were
Note. ICU ¼ intensive care unit.
compared with subscale scores and total ICES scores. Mann-
Whitney U test was used for the analysis. The results were evalu-
ated at p  .05 and at 95% confidence interval. experiences than the younger group did (t ¼ 2.22, p ¼ .028). Pa-
tients with a primary education level remembered more fright-
Results ening experiences than the high school graduates did (t ¼ 2.78,
p ¼ .006). Married patients had higher total ICES scores (z ¼ 2.47,
The mean duration of stay in the ICU was 2.23 ± 2.89 days (range: p ¼ .013) and higher Satisfaction with Care subscale scores than
1.00e24.83 days). The sample characteristics indicated that most of single patients did (z ¼ 2.88, p ¼ .004). Patient who sensed smell
the patients were younger than 65 years (63.2%), male (71.7%), and had higher scores of frightening experiences than those who did
married (84.0%); 54.7% had a primary education level; 67.9% had not (z ¼ 2.94, p ¼ .030). Patients who were annoyed by the
another chronic illness; and 57.5% had previous ICU experiences. excessive light expressed lower satisfaction with care than those
Additionally, most of them were mechanically ventilated (98.1%); who were not (t ¼ 2.71, p ¼ .007). Patients suffering from
the mean duration of mechanical ventilation was 7.86 ± 4.16 hours mildemoderate pain were more satisfied with their care than pa-
(range: 2.00e26.00 hours). A majority of the patients (61.3%) had no tients suffering from severe pain (t ¼ 2.14, p ¼ .035) (Table 3).
visitors in the ICU, and a minority of the patients witnessed the
death of another patient during their ICU stay (12.3%). The mean
pain score in the ICU was 5.18 based on the data collected from the Discussion
VAS. According to the Glasgow Coma Scale, the level of conscious-
ness reached 15. All patients who sensed smell in the ICU defined it Patients were moderately aware of their intensive care envi-
as a bad smell, whereas all of the patients who were disturbed by the ronment. Although 98.1% of the patients had been mechanically
light thought it was at an excessive level (Table 1).
The mean ICES score was 64.15 ± 6.56. Subscale scores were as
Table 2 Scores of ICES in Cardiovascular Surgery Patients (N ¼ 106).
follows: (a) Awareness of Surroundings was 19.97 ± 2.62 (range:
13.00e25.00); (b) Recalling Experiences was 13.34 ± 3.37 (range: Subscales of ICES M ± SD MineMax
6.00e20.00); (c) Frightening Experiences was 15.11 ± 5.31 (range:
Awareness of Surroundingsa 19.97 ± 2.62 13e25
6.00e27.00); and (d) Satisfaction with Care was 15.71 ± 2.73 Recall of Experienceb 13.34 ± 3.37 6e20
(range: 10.00e20.00), as shown in Table 2. Frightening Experiencesc 15.11 ± 5.31 6e27
Patients in the 65 years and older group less frequently recalled Satisfaction With Cared 15.71 ± 2.73 10e20
their ICU experiences than the younger group did (t ¼ 2.16, Note. ICES ¼ Intensive Care Experiences Scale.
p ¼ .033) and more frequently remembered their frightening a
Score ranges in the original ICES: 5e25; b4e20; c6e30; d4e20.
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Table 3 ICU Experiences of Cardiovascular Surgery Patients and Associated Factors (N ¼ 106).

Factors Classifications Awareness of Surroundings Recall of Experience Frightening Experiences Satisfaction With Care Total scale

M ± SD Statistics M ± SD Statistics M ± SD Statistics M ± SD Statistics M ± SD Statistics

Age (yr) < 65 20.20 ± 2.59 t ¼ 1.22 13.88 ± 3.61 t ¼ 2.16 14.25 ± 4.64 t ¼ 2.22 15.92 ± 2.77 t ¼ 1.03 64.26 ± 7.23 t ¼ 0.24
 65 19.56 ± 2.65 p ¼ .224 12.43 ± 2.74 p ¼ .033* 16.58 ± 6.08 p ¼ .028* 15.35 ± 2.66 p ¼ .306 63.94 ± 5.30 p ¼ .841
Gender Male 20.17 ± 2.32 t ¼ 1.24 13.26 ± 3.45 t ¼ 0.41 15.64 ± 5.12 t ¼ 0.26 15.02 ± 2.73 t ¼ 0.43 64.10 ± 6.49 t ¼ 0.11
Female 19.46 ± 3.25 p ¼ .215 13.56 ± 3.21 p ¼ .685 15.90 ± 5.85 p ¼ .790 15.33 ± 2.75 p ¼ .667 64.26 ± 6.84 p ¼ .910
Education Primary school 19.86 ± 2.63 t ¼ 0.47 13.17 ± 3.49 t ¼ 0.59 16.37 ± 5.72 t ¼ 2.78 15.36 ± 2.69 t ¼ 1.47 64.51 ± 5.01 t ¼ 1.23
High school 20.10 ± 2.62 p ¼ .639 13.56 ± 3.25 p ¼ .556 13.58 ± 4.36 p ¼ .006* 16.14 ± 2.74 p ¼ .142 63.39 ± 4.18 p ¼ .220
Marital status Married 20.06 ± 2.74 z ¼ 1.17 13.43 ± 3.57 z ¼ 0.61 15.17 ± 5.47 z ¼ 0.00 16.06 ± 2.64 z ¼ 2.87 64.58 ± 4.48 z ¼ e2.47
Single 19.47 ± 1.84 p ¼ .242 12.88 ± 2.11 p ¼ .538 14.76 ± 4.53 p ¼ 1.000 13.88 ± 2.49 p ¼ .004* 61.00 ± 4.56 p ¼ .013*
Comorbidity Yes 19.75 ± 2.83 t ¼ 1.27 13.29 ± 3.38 t ¼ 0.25 15.15 ± 5.59 t ¼ 0.11 15.88 ± 2.63 t ¼ 0.94 64.08 ± 6.89 t ¼ 0.15
No 20.44 ± 2.06 p ¼ .207 13.47 ± 3.40 p ¼ .800 15.02 ± 4.73 p ¼ .912 15.35 ± 2.94 p ¼ .348 64.29 ± 5.89 p ¼ .878
Previous ICU Yes 19.75 ± 2.76 t ¼ 0.99 13.22 ± 3.43 t ¼ 0.42 15.29 ± 5.39 t ¼ 0.40 15.62 ± 2.64 t ¼ 0.41 63.90 ± 6.14 t ¼ 0.45
experience No 20.26 ± 2.41 p ¼ .323 13.51 ± 3.33 p ¼ .673 14.86 ± 5.24 p ¼ .684 15.84 ± 2.87 p ¼ .682 64.48 ± 7.15 p ¼ .659
Duration in 2 19.91 ± 2.69 t ¼ 0.40 13.25 ± 3.49 t ¼ 0.52 14.92 ± 5.43 t ¼ 0.63 15.90 ± 2.75 t ¼ 1.21 63.98 ± 6.54 t ¼ 0.44
ICU (days) >2 20.15 ± 2.42 p ¼ .686 13.65 ± 3.03 p ¼ .599 15.69 ± 4.98 p ¼ .525 15.15 ± 2.61 p ¼ .228 64.65 ± 6.73 p ¼ .655
Duration of 6 20.00 ± 2.40 t ¼ 0.19 13.77 ± 3.24 t ¼ 0.99 15.25 ± 4.62 t ¼ 0.55 15.84 ± 2.50 t ¼ 0.26 64.86 ± 6.95 t ¼ 0.97
mechanical >6 20.10 ± 2.67 p ¼ .844 13.10 ± 3.50 p ¼ .321 14.68 ± 5.56 p ¼ .584 15.70 ± 2.88 p ¼ .795 63.58 ± 6.34 p ¼ .331
ventilation
(hours)
Any visitors Yes 20.41 ± 2.39 t ¼ 1.38 13.29 ± 3.48 t ¼ 0.13 15.17 ± 5.31 t ¼ 0.08 16.21 ± 2.80 t ¼ 1.51 65.09 ± 5.83 t ¼ 1.18
No 19.69 ± 2.73 p ¼ .169 13.38 ± 3.33 p ¼ .892 15.07 ± 5.35 p ¼ .930 15.40 ± 2.65 p ¼ .133 63.55 ± 6.95 p ¼ .240
Being witness Yes 20.38 ± 2.69 z ¼ 0.44 14.00 ± 3.67 z ¼ 0.83 15.76 ± 6.04 z ¼ 0.42 16.46 ± 2.47 z ¼ 1.05 66.61 ± 5.40 z ¼ 1.69
to any death No 19.91 ± 2.62 p ¼ .653 13.25 ± 3.34 p ¼ .401 15.02 ± 5.23 p ¼ .671 15.61 ± 2.76 p ¼ .293 63.80 ± 6.66 p ¼ .091
in ICU
Bad smell Yes 20.13 ± 2.74 z ¼ 0.13 13.41 ± 3.64 z ¼ 0.15 17.37 ± 4.43 z ¼ 2.94 15.17 ± 2.86 z ¼ 1.26 66.10 ± 7.53 z ¼ 1.33
No 19.90 ± 2.59 p ¼ .894 13.32 ± 3.29 p ¼ .875 14.25 ± 5.39 p ¼ .030* 15.92 ± 2.30 p ¼ .207 63.41 ± 6.05 p ¼ .183
Excessive light Yes 20.14 ± 1.55 z ¼ 0.16 12.90 ± 2.52 z ¼ 0.79 16.04 ± 4.48 z ¼ 1.19 14.33 ± 2.00 z ¼ 2.71 63.42 ± 4.57 z ¼ 0.57
No 19.92 ± 2.83 p ¼ .872 13.45 ± 3.56 p ¼ .429 14.88 ± 5.49 p ¼ .231 16.05 ± 2.78 p ¼ .007* 64.32 ± 6.97 p ¼ .565
Pain Mild-moderate 20.23 ± 2.53 t ¼ 1.79 13.09 ± 3.29 t ¼ 0.81 14.43 ± 4.80 t ¼ 1.36 16.25 ± 2.71 t ¼ 2.14 64.01 ± 5.64 t ¼ 0.21
pain
Severe pain 19.68 ± 2.71 p ¼ .283 13.62 ± 3.48 p ¼ .416 15.84 ± 5.77 p ¼ .174 15.13 ± 2.65 p ¼ .035* 64.29 ± 7.48 p ¼ .830

Note. ICU ¼ intensive care unit. *p  .05.

ventilated, the duration of mechanical ventilation was short beginning of their disorder, the unusual ICU environment and a
(7.86 ± 4.16 hours); this situation can positively affect the patient's feeling of uncertainty during their suffering process in the ICU [12].
status of being environmentally aware. Mechanically ventilated ICU patients experienced mostly pain and sleep disorders
patients remembered that they had been in an unusual environ- [17,40,41], and patients associated staying in the ICU with death
ment [9]. One study conducted in Turkey found that ICU patients [25].
were aware of their surroundings [22]. Different from our results, Patients who were 65 years and older recollected their fright-
cardiovascular surgery patients reported that they were not ening experiences more than younger patients did; this can be
familiar with the medical environment and politics after their explained by increased number of health problems associated with
release from the ICU. Furthermore, they experienced mental and the aging process and the fact that elderly people may be exposed
physical uneasiness because of the examinations in the ICU and to various medical procedures. Unlike our results, one study
their changeable health status [7]. determined that young patients (< 50 years) more frequently had
Patients partly remembered intensive care experiences. This more delusional experiences than older patients did [10]. In our
finding is consistent with the results of studies regarding the ICU sample, patients were classified as two groups: “younger than 65
experiences of cardiovascular surgery patients [4e6] and patient years” and “65 years and older”. In yet another study, there was no
experiences in various ICUs [10,11,13,39]. As examined from a qual- statistically significant difference among the age groups regarding
itative perspective, patients after cardiovascular surgery recalled frightening experiences [30].
their confusion in the ICU. They also experienced anxiety at the point Patients with a primary education level remembered more
between their awareness and unawareness status in the ICU [15]. frightening experiences than patients with other education levels
Patients who were 65 years and older less frequently recollected did. This result can be attributed to the fact that patients with a
their ICU experiences than younger patients did. This result can be primary education level could have inadequate information about
attributed to the slower cognitive functions of elderly patients that their environment and have difficulty in gaining or understanding
are associated with the aging process. Unlike our results, two information in the written education materials provided to them.
studies showed that ICU experiences did not differ between age Different from our results, other studies reported that patients'
groups [22,30]. These findings can result from different sample experiences did not significantly differ with their education levels
sizes and heterogeneous samples from different ICUs (surgery, [19,22].
gynaecology-obstetrics, cardiovascular surgery, cardiology, internal The patient satisfaction with care level was good. Similar to our
medicine and neurology) in their studies. results, some studies have indicated that CS ICU patients felt secure
CS patients highly recalled frightening experiences in the ICU. [15,20]. According to the reports of ICU patients, support and care
This finding was consistent with the results of studies related to the practices were the main theme and most important things in the
ICU experiences of cardiovascular surgery patients [4,6,20,21]. Pa- ICU [40]. In an intervention study, a positive effect was noted in
tients reported unreal ICU experiences and delusional memories patients who were treated in a positive environment that contained
regarding other ICUs [10]. In one Jordanian study, female patients encouraging values and feelings of motivation and trust, where
had difficulty interpreting their experiences due to the sudden patients received additional care and participated in desired care
340 € Aslan, B. Tosun / Asian Nursing Research 9 (2015) 336e341
O.

activities [26]. Based on this perspective, one study found that sociodemographic and clinical characteristics, such as age, educa-
patients' suggestions to relieve suffering in the ICU were commu- tion level, marital status and pain level. Necessary measures should
nication, participation in care activities and companionship [8]. ICU be taken to accommodate patients with a primary school education
patients expressed the “need for the presence of the nurse” [42]. level, patients who are 65 years old or older, and patients who are
The satisfaction with care of the ICU patients was in the middle single, as they expressed negative experiences in certain areas. In
level [22]. Inconsistent with our results, studies have shown that this context, CS nurses can provide preoperative face-to-face edu-
ICU patients stated that the nurses had not listened, had not un- cation to ensure that the patients understand the procedures and
derstood and had not talked with the patients and instead focused cardiovascular CS ICU environmental factors. Additionally, effective
on practical activities [25]. communication techniques should be used during nursing care.
Patients with a mildemoderate pain level were more satisfied CS ICU architecture factors are important for promoting patient
with their care than those who suffered from severe pain. This recovery. Adequate natural sunlight and pleasant smells can be
situation can be explained by the possibility of ineffective pain used in the intensive care environment. CS nurses can assume a key
management due to the complicated nature of pain. CS ICU patients role in selecting and using these modalities based on evidence
had various levels of pain [4,6,24]. One study reported that satis- based guidelines. For example, bad smells can be removed from ICU
faction with care did not differ depending on the patients' pain by special systems. Nurses can inquire patient's smell preference
status in the ICU [30]. before their ICU stay in the context of nursing health history. Nurses
Married patients were more satisfied with the care than single can also direct the healthcare team in the decision-making process.
individuals were. Single patients may have felt lonelier and could Further research can focus on measuring intervention effects
have had higher expectations of the care they would receive. There aimed at improving patient satisfaction with care in CS ICUs. The
are contradictory results in the scientific literature; for example, results from studies using standardized tools and exploring various
one study stated that married ICU patients had more negative ex- environmental factors, such as color and music, will provide valu-
periences [19], whereas another study showed ICU experiences did able information to the cardiovascular healthcare team.
not differ with marital status [22]. These findings can result from
different sample sizes. Conflicts of Interest
Most of the patients had previous intensive care experiences,
had a moderate pain level, stayed in the ICU for a relatively short The authors declare no conflicts of interest.
period of time and were mechanically ventilated for a short time.
Patients who sensed smell in the ICU had more frightening ex- Acknowledgments
periences than those who did not. All patients who sensed smell in
the ICU defined it as a bad smell. This finding can be explained by This study was presented as a poster presentation in 26th
the fact that the patients perceive smell as a powerful environ- Annual Congress of the European Society of Intensive Care Medi-
mental component. Removing unpleasant smells is one of the cine on October 5e9, 2013 in Paris, France.
important issues when designing hospital care environments [27].
Using aromatherapy was emphasized as a strategy to improve References
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